23 June 2006

 

Avian Influenza - human cases in Indonesia and China

 

Indonesia

The Ministry of Health in Indonesia has confirmed a case of human avian influenza in a 13 year old boy from South Jakarta [1]. He developed symptoms on 9 June 2006, one week after helping his grandfather kill infected chickens at the family home. He was admitted to hospital on 13 June and died on 14 June. His grandfather currently remains healthy. Monitoring and contact tracing are taking place to ensure no further cases arise from this exposure setting.

Prior to this, the Ministry of Health reported a fatal case of human avian influenza in a 7 year old girl from the Tangerang district of Banten Province. She became unwell on 26 May 2006, was admitted to hospital on 30 May and died on 1 June [2]. Her 10 year old brother died of a respiratory illness on 29 May, no specimens were taken for testing and therefore the cause of his death cannot be established. A history of chicken mortality in the household prior to the onset of symptoms was reported. Laboratory testing of the girl’s family and contacts has not identified any further cases [2].

The Indonesian Government’s National Commission on Avian and Pandemic Influenza has requested a joint consultation to assess the avian influenza situation in Indonesia. The consultation will take place from 21 to 23 June and will be attended by over 40 national and international experts from the World Health Organization, the Food and Agriculture Organization of the United Nations (FAO) and the Indonesian ministries of health and agriculture [1]. Experts will examine the epidemiological and virological data collected during the month long investigation of the cluster in North Sumatra [3]. More than 3 weeks has passed since the last case in the cluster died on 22 May, and no further cases have been identified during the investigation. The maximum incubation period has now been exceeded. Examination of the results from the investigation may yield helpful lessons in the management of clusters where human to human transmission is suspected [1].

China

The Ministry of Health in China has confirmed a case of human avian influenza in a 31 year old male truck driver from Shenzhen City, Guangdong Province, near the Hong Kong border. He developed symptoms on 3 June and was admitted to hospital, where he remains in a critical condition with severe pneumonia [3]. He was thought to have visited a live poultry market prior to becoming unwell. H5N1 infection in poultry has not been officially reported in the area.

Global Cases Totals

The global total of laboratory cases reported by WHO as of      

is in the table below and can be found on the WHO website at:

http://www.who.int/csr/disease/avian_influenza/country/

cases_table_2006_06_20/en/index.html

COUNTRY	HUMAN CASES as of 20 June 2006					DEATHS
	2003	2004	2005	2006	TOTAL
Azerbaijan	0	0	0	8	8	5
Cambodia	0	0	4	2	6	6
China	0	0	8	11	19	12
Djibouti	0	0	0	1	1	0
Egypt	0	0	0	14	14	6
Indonesia	0	0	17	34	51	39
Iraq	0	0	0	2	2	2
Thailand	0	17	5	0	22	14
Turkey	0	0	0	12	12	4
Viet Nam	3	29	61	0	93	42
TOTALS	3	46	95	84	228	130

The WHO has posted maps of the current epidemiology of human cases of avian influenza.  A map delineating cases of human avian influenza through 30 May 2006 can be viewed at: http://gamapserver.who.int/mapLibrary/Files/Maps/

Global_H5N1inHumanCUMULATIVE_2006052430.png 

Advice for travellers

Examination of previous human cases of avian influenza has indicated that the greatest risk for transmission from birds to humans comes when there is close human contact with domestic poultry. This is particularly so in settings of diseased household flocks and when there has been slaughtering, de-feathering, and preparation of poultry for consumption. No cases have been linked to consumption of properly cooked meat or eggs.

There remain no restrictions for travel to countries with avian influenza. Nevertheless, travellers should exercise precautions [5].

The Health Protection Agency (HPA), Centre for Infections has published an algorithm for the management of travellers or visitors arriving from countries (or areas within countries) affected by avian influenza [6]. These regions are revised as new information is provided from the WHO and the World Organisation for Animal Health (OIE) on detection of avian influenza.

The HPA algorithm provides guidance on the recognition, investigation and management of persons with fever or history of fever and respiratory symptoms, and who have had an exposure to persons or birds with suspected avian influenza within seven days of their arrival in the UK. Physicians who see persons whom they suspect may have avian influenza should evaluate them according to this algorithm.

References

1. World Health Organization. Avian Influenza - situation in Indonesia - update 20. 20 June 2006 [cited 22 June 2006]. Available online at:

http://www.who.int/csr/don/2006_06_20/en/index.html

2. World Health Organisation. Avian influenza - situation in Indonesia - update 19. 15 June 2006 [cited 22 June 2006]. Available online at:

http://www.who.int/csr/don/2006_06_15/en/index.html

3. World Health Organization. Avian influenza - situation in Indonesia - update 14. 23 May 2006 [cited 23 June 2006] Available online at http://www.who.int/csr/don/2006_05_23/en/index.html

4. World Health Organization. Avian Influenza - situation in China - update 12. 16 June 2006 [cited 22 June 2006]. Available online at: http://www.who.int/csr/don/2006_06_16/en/index.html

5. NaTHNaC. Avian influenza - advice for travellers to affected areas. 7 April 2006. [cited 22 June 2006] Available online at: http://www.NaTHNaC.org/pro/clinical_updates/

avianinfluenza_traveladvice_070406.htm

6. Health Protection Agency. Algorithm for the management of returning travellers and visitors from countries affected by avian influenza (H5N1) presenting with a febrile respiratory illness: recognition, investigation and initial management. 19 June 2006 [cited 22 June 2006] Available online at: http://www.hpa.org.uk/infections/topics_az/influenza/avian/

algorithm.htm